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Drug of the Day

A review of current practice and administration. Refer to Lexi-Comp for more detailed information.

Buprenorphine (Buprenex, Subutex, Butrans)
Guide to emergency department pain management with buprenorphine
Administration (Adults)



AHS ED Indication


Adverse Drug Reactions

Sublingual tablets:
 Place under the tongue until dissolved
 If 2 or more tablets are needed per dose, can place all
under the tongue at once or 2 tablets at a time

In general, similar to other opioids:
 Nervous system, respiratory, cardiovascular,
gastrointestinal, ocular, and dermatologic
Precipitated withdrawal
 Rapid withdrawal symptoms can occur in
opioid dependent patients
 Wait 12 hours after last dose of a short acting
opioid (e.g. heroin ) or 24 hours after last
dose of a long-acting opioid (e.g. MS Contin)
 If patient is in objective moderate to severe
withdrawal, it is OK to give buprenorphine

Treatment of acute pain in patients with a
history of opioid/substance abuse not on
methadone. For these same patients,
buprenorphine can be continued upon
OR as continuation of a home medication

Common ED Doses

Sublingual: 2-8mg x1
Injectable (IV or IM): 0.3mg x1
Transdermal: 5-20mcg/h

Oftentimes the injectable or sublingual dose can be
followed by a transdermal dose

Same monitoring as with any other opioid; watch for
respiratory depression, and hypotension

 IV push over at least 2 minutes
 Administer by deep IM injection
Transdermal Patch: (patient should stop other opioids)
 Slow onset; low risk of precipitating withdrawal in most
cases. May need bridge of analgesia for first 24 hours.
 Clean area with water only and allow to dry completely
 Examine patient for any old patches and remove
 Ensure skin site is non-irritated and hairless
 To apply: 1) Remove the protective backing 2) place
sticky side of the patch to the upper outer arm, upper
chest, upper back or side of the chest 3) firmly press and
hold patch in place for ~15 sec
 Label patch with date, time, and initials


May have cross-sensitivity with other opioids
High risk of precipitated withdrawal among
methadone users

Derex Louie PharmD, Tina Liu, PharmD, Andrew Herring, MD, JFProvinse, MS, RN 7/16  References: Lexi-Comp for buprenorphine accessed 6-28-16